title: A randomized, double-blind, multicenter comparison study of triple antiplatelet therapy with dual antiplatelet therapy to reduce restenosis after drug-eluting stent implantation in long coronary lesions: results from the DECLARE-LONG II (Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients with Long Coronary Lesions) trial.
abstract: OBJECTIVE
  The purpose of this study was to determine whether cilostazol reduces intimal hyperplasia in patients undergoing long zotarolimus-eluting stent implantation (stent length: ≥ 30 mm) for native long coronary lesions (length: ≥ 25 mm).
  
  
  BACKGROUND
  Restenosis after drug-eluting stent implantation remains a significant clinical problem in long coronary lesions.
  
  
  METHODS
  Patients (n = 499) were assigned randomly to triple (aspirin, clopidogrel, and cilostazol, triple group: n = 250) or dual antiplatelet therapy (aspirin and clopidogrel and placebo, dual group: n = 249) for 8 months after long zotarolimus-eluting stent implantation. The primary end point was in-stent late loss at the 8-month angiography according to the intention-to-treat principle.
  
  
  RESULTS
  The 2 groups had similar baseline characteristics. The in-stent (0.56 ± 0.55 mm vs. 0.68 ± 0.59 mm, p = 0.045) and in-segment (0.32 ± 0.54 mm vs. 0.47 ± 0.54 mm, p = 0.006) late loss were significantly lower in the triple versus dual group, as were 8-month in-stent restenosis (10.8% vs. 19.1%, p = 0.016), in-segment restenosis (12.2% vs. 20.0%, p = 0.028), and 12-month ischemic-driven target lesion revascularization (5.2% vs. 10.0%, p = 0.042) rates. At 12 months, major adverse cardiac events including death, myocardial infarction, and ischemic-driven target lesion revascularization tended to be lower in the triple group than the dual group (7.2% vs. 12.0%, p = 0.07). Percent intimal hyperplasia volume by volumetric intravascular ultrasound analysis was reduced from 27.1 ± 13.2% for the dual group to 22.1 ± 9.9% for the triple group (p = 0.017).
  
  
  CONCLUSIONS
  Patients receiving triple antiplatelet therapy after long zotarolimus-eluting stent implantation had decreased extent of late luminal loss, percent intimal hyperplasia volume, and angiographic restenosis, resulting in a reduced risk of 12-month target lesion revascularization compared with patients receiving dual antiplatelet therapy. (Triple Versus Dual Antiplatelet Therapy after ABT578-Eluting Stent; NCT00589927).
authors.affiliation: Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. swpark@amc.seoul.kr
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Jae-Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Si Wan
authors.initials: SW
authors.lastname: Choi
authors.forename: In-Whan
authors.initials: IW
authors.lastname: Seong
authors.forename: Nae-Hee
authors.initials: NH
authors.lastname: Lee
authors.forename: Yoon Haeng
authors.initials: YH
authors.lastname: Cho
authors.forename: Won-Yong
authors.initials: WY
authors.lastname: Shin
authors.forename: Seung-Jin
authors.initials: SJ
authors.lastname: Lee
authors.forename: Se-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Min-Su
authors.initials: MS
authors.lastname: Hyon
authors.forename: Duk-Won
authors.initials: DW
authors.lastname: Bang
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Choi
authors.forename: Hyun-Sook
authors.initials: HS
authors.lastname: Kim
authors.forename: Bong-Ki
authors.initials: BK
authors.lastname: Lee
authors.forename: Keun
authors.initials: K
authors.lastname: Lee
authors.forename: Hoon-Ki
authors.initials: HK
authors.lastname: Park
authors.forename: Chang-Bum
authors.initials: CB
authors.lastname: Park
authors.forename: Sang-Gon
authors.initials: SG
authors.lastname: Lee
authors.forename: Min-Kyu
authors.initials: MK
authors.lastname: Kim
authors.forename: Kyoung-Ha
authors.initials: KH
authors.lastname: Park
authors.forename: Woo-Jung
authors.initials: WJ
authors.lastname: Park
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D000077407:Cilostazol; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011446:Prospective Studies; D011859:Radiography; D013777:Tetrazoles / Q000008:administration & dosage*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin